Abstract
Purpose: The operative method of fundoplication for gastroesophageal reflux disease (GERD) is divided into anterior wrapping (AW), such as Dor fundoplication, and posterior wrapping (PW), such as Toupet and Nissen fundoplications. Our institute introduced laparoscopic fundoplication in 2002. AW was performed until 2010, and PW has been performed since 2011. We examined the outcomes of AW and PW.
Methods: We examined 33 cases that we encountered from 2002 to 2013 and compared them retrospectively. The median age was 4 years (0-39 years), 26 patients were boys, and 7 were girls.
Results: Twenty-four patients showed severe motor and intellectual disabilities, six had congenital hiatal hernia, and three showed postoperative esophageal atresia. AW (Dor) was performed in 18 patients, and PW (Nissen fundoplication for 9 patients, Toupet fundoplication for 6 patients) was performed in 15 patients. Compared with AW (p < 0.05), PW is associated with significantly reduced blood loss and operation time. Recurrence was observed in three patients subjected to AW (16.7%) and in 1 patient subjected to PW (6.7%). The recurrence rate was significantly reduced in the PW group. There was no significant difference between Nissen and Toupet fundoplications in terms of recurrence. For the 3 patients who showed recurrence in the AW group, 1 underwent reoperation and 2 were treated conservatively. One patient who underwent Toupet fundoplication showed recurrence.
Conclusions: In our institute, PW was found to be associated with significantly less operation time and intraoperative blood loss than AW. PW is a better procedure than AW for GERD. It was considered important to determine the condition of the patient in the selection of PW as the operative method. In particular, Nissen fundoplication is useful for patients with severe motor and intellectual disabilities.
